POSTOPERATIVE VENOUS INSUFFICIENCY AND DEEP VENOUS THROMBOSIS IN TOTAL HIP REPLACEMENT: THE EFFECTS OF EPIDURAL AND GENERAL ANESTHESIA

Abstract

Introduction: The anesthetic techniques in total hip replacement may effect the risk of postoperative deep venous thrombosis.
Methods: This study investigates the effects of epidural (n = 14) and general (n = 15) anesthesia on postoperative venous insufficiency and deep venous thrombosis in patients with total hip replacement. General anesthesia group received heparin prophylaxis subcutaneously 2 x 5000 U for 7 days. Epidural anesthesia group did not receive prophylactic heparin. During postoperative 3 days, epidural anesthesia group received 5 ml 2% lidocaine at each 8- hour interval via epidural catheter. Blood samples were collected for hemoglobin, hematocrit, aPTT, PT, AT III, and fibrinogen just before the operation, 1 hour after incision, and at 3, 24 and 72 hours postoperatively. Venous Doppler ultrasound of the lower limbs were taken before and 7 days after the operation. Intraoperative blood loss, blood and fluid replacement were recorded.
Results: Intraoperative blood loss and transfusion requirements were lower but fluid replacement was higher in the epidural anesthesia group than the general anesthesia group (p< 0.05). Fibrinogen and AT III levels were lower in the general anesthesia group than the epidural anesthesia group (p<0.05), during the operation and at the postoperative 72 hours respectively. Doppler ultrasound revealed that the incidence of postoperative venous insufficiency was more frequent in the general anesthesia group (p<0.05), but no difference was observed for deep venous thrombosis in both groups.
Conclusion: We conclude that the epidural anesthesia in total hip replacement may decrease intraoperatively blood loss and postoperative venous insufficiency, thus it may decrease the risk of postoperative venous thrombosis.